Postnatal Depression Awareness Week 2011 - Postnatal in men

There is a widespread belief that antenatal and postnatal depression is only experienced by women. Research and anecdotal evidence suggests that this is not the case. It is believed that around one in 14 men will experience depression during the antenatal and postnatal period, with some evidence suggesting that the figure could be as high as one in three. It is often maintained that men experience depression as a result of or in conjunction with their partner’s depression. While maternal postnatal depression is the strongest predictor of paternal postnatal depression it is not always the case. Men can experience antenatal and postnatal depression independently from their partners.

Depression in new fathers has been found to begin in the antenatal period with minimal recovery by the end of the first year (Condon, Boyce & Corkindale, 2004). There is also evidence to suggest that men’s depression increases between six weeks and six months after childbirth. Ballard et al (1994 as cited in Bielawska-Batorowicz & Kossakowska-Petrycka, 2006) found that three out of ten men were depressed at six weeks and that their depression escalated during the next six months.

New fathers do not access the sort of services that new mothers do such as their doctor, maternal and child health nurse or midwife. This is where problems for women are often picked up.

Contributing factors for PND

Bio-psycho-Social Factors
As with all forms of depression there are a range of bio-psycho-social factors that contribute to the development of paternal postnatal depression: some physical, some emotional and some social. Some factors are the same as those that contribute to women experiencing antenatal and postnatal depression and others are related to the man’s experience of pregnancy and new fatherhood.

Factors that effect men which are similar to those effecting women include:
• lack of social and emotional support
• personality characteristics
• stress and changes in relationships (particularly the couple relationship)
• lack of sleep
• loss and grief issues
• difficulty adjusting to the changes associated to the transition to parenthood
• unmet prenatal expectations
• negative or traumatic birth experience - the way in which men experience childbirth may have some influence on their subsequent emotional well-being.

Factors that generally seem relate to the man’s experience:
• the impact of changing social roles for fathers in the family
• norms and attitudes toward fatherhood and masculinity – men are less likely to talk about how they feel and maintaining that they are coping is very important
• change in family dynamics so that some men may feel excluded from the parenting role or from the relationship with their partner. This may result in resentment towards the baby.
• worries about extra responsibilities, financial burdens and managing the stresses of work
• unmet expectations for the resumption of the sexual relationship in the early postnatal period
• pregnancy, particularly early on, appears to be the most stressful period for men in the transition to fatherhood. This may be due to changes to his partner’s body, how supported and included he feels, concern about the pending changes to his life and feeling unsure about his role in caring for his partner.

Some men experience postnatal depression in conjunction with their partner’s depression. Studies have shown that maternal and paternal depression are highly correlated (Ramchandani et al, 2005; Meighan et al, 1999). Men report experiencing their partner’s postnatal depression as causing disruption in their lives and their relationship with their partners. They experience fear, confusion and a sense of helplessness that they are unable to help their partners overcome their depression (Meighan et al, 1999), as well as a sense of disconnection and alienation from their partners. They experience postnatal depression as overwhelming, isolating, stigmatizing and frustrating
(Davey et al, 2006).

Risk Factors
Some men may not be able to identify any of the risk factors in their lives yet still develop postnatal depression. Paternal postnatal depression can affect men of all ages, personality types and economic status. Some of the known risk factors associated with paternal postnatal depression include:
• Partner experiencing postnatal depression
• Previous history of depression
• Marital problems
• Low self-esteem
• Feelings of incompetence in parenting role
• First time father
• Infant irritability

Symptoms
Paternal postnatal depression is still unrecognized in psychiatric diagnostic literature. It is assumed (but not evidenced) that some of the symptoms of paternal postnatal depression are similar to those in maternal postnatal depression. These include:
• Tiredness, headaches and pain
• Irritability, anxiety and anger
• Loss of libido
• Changes in appetite
• Feelings of being overwhelmed, out of control and unable to cope
• Engaging in risk taking behaviour
• Feelings of isolation and disconnection from partner, friends or family
• Withdrawal from intimate relationships and from family, friends and community life
• Increased hours of work as a part of the withdrawal from family etc
• Increased use of drugs or alcohol instead of seeking treatment for depression

Father’s experiences
• Some fathers describe their experience of postnatal depression as being trapped, almost like pacing a cage, of feeling extremely alone in their situation and not knowing how to get out of it
• Other fathers experience postnatal depression as being overcome with anger and rage. They feel angry at their partners, children or other family members. They can feel confused about why their feelings and are often shocked at their own behaviour.
• Some are overwhelmed by feelings of hopelessness and helplessness that their lives and sense of self may never return to normal.
• Some fathers feel disappointed by their experience of fatherhood and that they have failed in their role as a father and they have let themselves, their children or partners down. They may feel that fatherhood has not been what they expected and feel let down.

Effects on Child Development
Paternal postnatal depression can have specific and persisting detrimental effects on children’s development. Research has shown that depression in fathers in the postnatal period is associated with poorer social and emotional behavioural outcomes in children at age three, particularly in boys, even when maternal depression is not present (Ramchandri et al, 2005). Men with depression are also less likely to read to or play with their children. It is important that postnatal depression in fathers is recognized and treated early and effectively.

Treatment

There are some strategies and treatment options available for fathers who may be experiencing postnatal depression. Some of these include;
• Contact PANDA for support, information and referral to services for men experiencing postnatal depression and their families.
• Visit your doctor for a full medical and mental health assessment, to clearly establish what is going on.
• Your doctor may suggest antidepressant medication to help reduce some of the symptoms. These are effective for many people, especially in conjunction with counselling and are preferable to the use of alcohol or illicit drugs. Your doctor, pharmacist or a drug information helpline will be able to provide more information.
• Ask your doctor for a referral to a psychologist or psychiatrist who specialises in postnatal depression. You may be eligible for Medicare rebates.
• Seek extra support. Go along to your baby’s next maternal and child health nurse appointment and discuss your situation with the nurse. She may be aware of other local services.
• Support groups. It is very common for women experiencing postnatal depression to attend support groups. These groups can be immensely beneficial but there are very few groups established for men. It might be worth alerting your community health care centre to this gap or talk PANDA about setting one up in your area.
• Seek emotional and practical support from your partner, your family and friends, your work colleagues, anyone who is willing to help. The nature of depression will probably mean you feel isolated and alone. Asking for help, talking things through, even just spending more time with the people you love can help you to re-connect with your positive feelings again.
• Lastly, be kind to yourself and remember there is a way out and you are not alone. There is help available and with the appropriate treatment, you can begin to feel better and come to enjoy being a new father. (Factsheet: Men and Postnatal Depression, PANDA)

It is wonderful that mental illness is becoming a more acceptable part of our society. I work in an antenatal clinic and find the amount of anxiety and depression overwhelming, it is almost abnormal not to have such an illness. Why is this so? My personal take on it all is that one of the reasons why depression in particular is so high is because of the immense pressure we either place upon ourselves, perceive to have or it is actually real. If we don't have the 'right' car, live in the 'right' street, look the 'right' way and have children who are absolute geniuses then we have failed as parents and human beings.

What is SO sad is the anxiety and depression we sees in young children. It is a vicious circle because they have to learn it from somewhere and as parents we are teaching our children the wrong way of handling certain situations and change. There really needs to be a national campaign starting in schools teaching children the coping mechanisms and involving their parents in this process so we are covering more than one base at a time.

It is a growing crisis really and I am very passionate about helping the small number of people I see but if I can point women in the right direction to receive the help and support they need which will provide them with skills for life, then I am doing something positive.

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